Malignant peritoneal mesothelioma (MPM) is a rare disease with an unusual natural history. The malignancy progresses within the abdomen and pelvis until gastrointestinal function is lost and a terminal event occurs. Systemic chemotherapy treatments are never curative and usually only have transient benefits. Over the past 2 decades surgical procedures have been developed that allow complete or near complete removal of MPM from the parietal and visceral peritoneal surfaces. The goal of the cytoreductive surgery (CRS) is complete visible removal of MPM. In an attempt to preserve the disease-free status an intraperitoneal chemotherapy lavage of the peritoneal space is performed. The intraoperative chemotherapy is called hyperthermic intraperitoneal chemotherapy (HIPEC). It is performed for 90 minutes with the temperature of the chemotherapy solution at 42-43°C. The CRS plus HIPEC combined treatment is currently a global standard of care with a 50% five-year survival published by multiple peritoneal surface malignancy treatment centers. At the Washington Cancer Institute, additional regional (intraperitoneal) chemotherapy treatments have been added in an attempt to further improve survival. These treatments are early postoperative intraperitoneal chemotherapy (EPIC) with paclitaxel and normothermic intraperitoneal chemotherapy (NIPEC) long-term with pemetrexed and cisplatin. These additional regional chemotherapy strategies added on to CRS and HIPEC caused the five-year survival to be approximately 80%. Although no randomized controlled data is available, propensity matched data are presented. Regional chemotherapy treatments long-term are suggested for further studies with MPM if complete CRS is possible.
Hyperthermia, Intraperitoneal Chemotherapy, Perioperative chemotherapy, Intraperitoneal port, Paclitaxel, Pemetrexed, Cisplatin, Cytoreductive surgery